NC0069957_Renewal (Application)_20151207

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit 000069957
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise,please print or type.
1. Contact Information:
Owner Name Mary Hensley
Facility Name Laurelwood Mobile Home Park
Mailing Address 47 Mayfair Drive
City Candler
State / Zip Code NC 28715
Telephone Number 828.768.3851
Fax Number 828.654.7544
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road Lower Beaverdam Loop Road
City Candler
State / Zip Code NC 28715
County Buncombe
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Goldie &Associates
Mailing Address 210-A W North Second Street
City Seneca
State / Zip Code SC 29768
Telephone Number 864.882.8194
Fax Number 864.882.0851
e-mail Address [e-mail]
4 - r__r AA 11/1

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that applys
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential ❑ Number of Homes
School ❑ Number of Students/Staff
Other X Explain: Mobile Home Park
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile Home Park
Number of persons served: 18
5. Type of collection system
x Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (NEW gMUcants:Provide a map shouring the exact location of each
outfalls
Beaverdam Creek-Tributary to French Broad River
S. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration:_
9. Describe the treatment system
List all installed components, including capacities,provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
A 0.002 MGD Wastewater Treatment facility consisting of 4 parallel 1000 gallon capacity septic
tanks followed by a 10 GPM pump station and three parallel 600 square foot subsurface sand
filters located at Laurelwood Mobile Home Park at the Intersection of NCSR3466 and
NCSR3449, South of Candler, Buncombe County, NC
n.L n I—I AA 11n

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.002 MGD
Annual Average daily flow 0.0006 MGD (for the previous 3 years)
Maximum daily flow 0.0008 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
_ Yes X No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed.Fecal Coliform, Temperature and pH shall be grab
samples,for all other parameters 24-hour composite sampling shall be used.If more than one analysis is reported,
report daily maximum and monthly average.If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading(Daily Maximum)and Monthly Average over
thepast 36 months for parameters curre tly in our ermit. Mark other parameters °`N/A".
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 45.Omg/L 30.Omg/L 2/month
Fecal Coliform 1/day
Total Suspended Solids 45.Omg/L 30.Omg/L 2/month
Temperature (Summer) Weekly
Temperature (Winter) Weekly
pH 2/month
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES NCO069957 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I_am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
i e YkSI,
Printed name of Person Sigding Title
u �Z�► � S
Sligriature of Applicant Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be
guilty of a misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (18 U.S.C.Section 1001
provides a punishment by a fine of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)

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Lon E. Hensley Facility
Location � 1,
Laurelwood Mobile Home Park (not to sale,
State Grid/USGS Quad: F 8 NW/Dunsmore Mtn.,NC Stream Class: C-Trout
Latitude: 35.29'43"N Longitude: 82141'23"W No NPDES Permit NCO069957
Receiving Stream: Beaverdam Creek[segment 6-76-5-81 Sub-Basin: 04-03-02
Drainage Basin: French Broad River Basin HUC:06010105 Buncombe County

12/1/2015
RE: NPEES PERMIT N0.0069957 RECEIVED/DENR/DWR
Laurelwood Mobile Home Park DEC ® 7 2015
Buncombe County
Water Quality
Please accept our apologies for the late application for the Permit. Permitting Section
My father had always managed the park himself and he passed away last April and my mother who is in
a nursing home now doesn't recall getting anything about it it the mail so somehow the expiration of the
permit"fell through the cracks". The email address on file was my fathers and is no longer valid.
I will be the person responsible for renewing this permit moving forward. The address and contact,
information have all been changed to my information. So please be sure to update the information in
your system.
Again I regret this happened and assure you it will not happen again.
Thank You.
a1
Lonnie Hensley

12/1/2015
NC DENR/Division of Water Quality/NPDES Unit RECEIVED/DENR/DWR
1617 Mail Service Center
Raleigh, NC 27699-1617 DEC ® 7 2015
Water Quality
RE: NPEES PERMIT NO.0069957 Permitting Section
Laurelwood Mobile Home Park
Buncombe County
Enclosed please find a Renewal Application for Permit to discharge treated wastewater from
Laurelwood Mobile Home Park to Beaverdam Creek,a tributary of the French Broad River in Buncombe
County, North Carolina.
There have been no changes since the issuance of the last permit.
Laurelwood Mobile Home Park does not generate any Solids.
Thank You.
ey
Lonnie Hensl